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Casualty & bodily injury · complex

Your adjusters assess liability and quantum.
They shouldn’t be assembling the requirement set.

On a claim that may end up in front of a court,
the file is the defence — and what is attacked is the gaps: what was not looked at, and why the position varies between adjusters.

When a decision is challenged, you can show every requirement that applied
and what the file evidenced against each one.

What your adjuster opens

A Case Orientation Report instead of a raw claim file.

Every requirement the claim engages — your policy terms, conditions and exclusions, the state claims-handling rules, and your own handling standards — identified for consideration, with the evidence on the file set against each one. It states the position on each requirement. It never reaches liability or quantum.

One requirement, as it appears in the reportIllustrative
The investigation standard set for a claim of this severity was met before the reserve was established.
Firm handling standard · internal · severity band as configured
Borderline
Statement taken and scene evidence obtained inside the period. The treating physician contact is logged four days late with no reason recorded. Flagged for the adjuster’s determination, never resolved for them.
Requirements are prepared this way across coverage, liability, causation, quantum and your own handling standards. Each one shows the requirement, its source, and what on the file answers it — or that nothing does.

Two rails, clearly separated. The statutory requirements for the jurisdictions you write in, and your own handling standards alongside them. Your adjuster can see at a glance which findings carry statutory exposure and which are your house rules.

It reports the file, not the adjuster. It states what the record shows and what it does not — never what anyone did or decided.

It can be run at the beginning, and again whenever the claim is updated, to orientate the adjuster. Requirements that did not exist at intake appear with their own deadlines, and evidence that was absent becomes present.


What it returns to the desk

A complete position on every requirement, before judgement begins.

Casualty runs against two clocks at once: the state claims-handling periods for acknowledging and deciding, and the litigation timetable once proceedings are on foot. Bodily injury severity has risen sharply and large verdicts are increasingly common. What is examined afterwards is rarely only the decision — it is what was considered before it, and whether the file can show it. Outcomer establishes which requirements the claim engages and checks the file against each one, so the position is recorded and dated at the time. Your adjuster keeps the judgement. Outcomer keeps the record.

An estimated 32% less time on each claim —
around 48% more capacity from the same team.

Estimated from a task-level decomposition of a complex liability claim at the point of evaluation, taking the conservative end of each range and including the time to run and read the report. Judgement minutes are unchanged — the saving is all preparation. These are our figures, not measurements on your claims; we go through the working against your own case timings in the demo.


Configured to your work

Configured to your rule book, and signed off before anything runs.

Three sets of requirements govern a casualty claim, and the report names all three. Your standards sit in your own configuration only. Nothing derived from them enters the shared regulatory corpus, and no other client’s configuration can draw on them.

The process rail

The state claims-handling rules for the jurisdictions you write in — acknowledgement, decision and communication periods. Public, identical for every carrier in that state, and built once. You review it and sign it off.

Your policy terms

Conditions, exclusions, limits and notice requirements from the wordings you write, decomposed into discrete requirements with the version in force at the date of loss. This is where coverage is decided, and it is yours.

Your handling standards

Investigation standards, reserve authority, escalation triggers and counsel referral criteria. You confirm the rendering represents your manual.

Maintenance is agreed at the same time — how the matrix stays current, how you tell us when your own standards change, and how each update is recorded. Requirements are date-gated, so a claim from 2021 is examined against the rules as they stood in 2021.


What changes for the desk

Six things your claims leader sees.

  1. Fewer decisions undermined by something that was on the file.A condition or exclusion nobody identified was never in the position taken.
  2. A dated record of what was considered before judgement.Not reconstructed at disclosure, and not dependent on the adjuster remembering.
  3. The same requirements applied whoever holds the file.Inconsistency between adjusters is the specific thing opposing counsel looks for.
  4. Fewer reserve surprises.An exposure nobody identified was never in the estimate.
  5. Fewer files back on a supervisor’s desk.The position on each requirement is complete and recorded the first time.
  6. More capacity from the adjusters you have.The time comes out of preparation, not out of the time spent deciding.

How it runs

In your estate, against the requirements in force at the time.

An orientation layer that sits alongside your claims administration system. Outcomer does not replace or write to it. It reads the file and states the position; your adjusters decide and update the record. No migration, no change to how claims are administered.

Outcomer deploys as a container inside your own environment. The software and the model run in your estate, and nothing about the claim — or your policy wordings — leaves your tenancy.

Built to fit your claims workflow. Outcomer can operate as a standalone workflow during evaluation, or integrate with your existing claims-management environment so the Case Orientation Report becomes another part of the adjuster’s existing workflow.

Schedule a 20-minute demo and see how it matches your desk’s work.

We will show you a Case Orientation Report, walk through how your policy terms and handling standards are decomposed and signed off, and go through what the record shows when a decision is challenged.